Author + information
- Julius I. Ejiofor1,
- Anju Nohria1,
- Anthony Norman2,
- Siobhan McGurk3,
- Douglas Shook4,
- Charles Nyman5,
- Piotr Sobieszczyk1,
- Pinak Shah1,
- Prem Shekar2,
- Marc Pelletier2 and
- Tsuyoshi Kaneko2
- 1Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- 2Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
- 3Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Massachusetts, United States
- 4Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- 5Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
Mediastinal radiation therapy(MRT) is a risk factor for adverse outcomes after surgical aortic valve replacement(SAVR). Transcatheter aortic valve replacement(TAVR) provides an alternative approach. However, data comparing TAVR to SAVR in patients with prior MRT are lacking.
We identified patients with prior MRT who had undergone isolated AVR between January, 2002(2012 for TAVR) and May, 2016 at our institution. Concomitant CABG was included, yielding 163 patients(SAVR=133, TAVR=30). Operative mortality and post-operative complications were compared between 30 pairs of STS risk score matched SAVR and TAVR patients.
Mean age was 78.1±8yrs vs. 70±9yrs for TAVR and SAVR, respectively(p=0.24). Among TAVR patients, 24/30(80%) were female vs. 20/30(66.7%) in SAVR, p=0.38. Mean STS risk score was 5.88±5% for TAVR and 5.91±3% for SAVR(p=0.94). 7/30 (23.3%) of TAVR and 5/30(16.7%) of SAVR patients had undergone prior cardiac surgery (p=0.57), and 48% of SAVR patients had concomitant CABG. TAVR was performed via a transfemoral approach in 24(80%), transaortic in 4(13.3%) and transapical in 2(6.7%). 30-day operative mortality was zero for TAVR and 3/30(10%) for SAVR (p=0.24). Post-operative stroke rate was 3.3%(1/30) in both groups(p=1.0). There was a higher incidence of new onset atrial fibrillation with SAVR(0% vs. 23.3%, p<0.011). TAVR had a shorter median ICU(21hrs vs. 58hrs, p<0.001) and hospital stay(4d vs. 12d, p<0.001). 1-year survival was 94.3% for TAVR vs 83.3% for SAVR(p=0.11) Figure.
Transcatheter aortic valve replacement appears to be an excellent alternative approach for valve replacement in patients with prior mediastinal radiation. It may afford lower post-operative morbidity and shorter hospital stay in this high risk population.
STRUCTURAL: Valvular Disease: Aortic